Cancer Therapies May Decrease Saliva and Increase Oral Health Problems: Reasons,
Symptoms and Solutions
Susan Zunt, DDS, MS
Decreased salivary flow resulting in a dry mouth is a frequent complication of cancer
Salivary gland hypofunction (reduced saliva) is caused by both chemotherapy
and/or radiation therapy. It is also a side effect of many common medications.
The symptoms include dryness, burning sensation on the tongue, fissures
on the tongue, atrophy of dorsal tongue surface, increased thirst, increased
dental caries (dental decay) and demineralization, and candidiasis (oral yeast
Decreased salivary flow can result in impaired lubrication of oral tissues
leading to: (1) a difficulty in speaking and/or swallowing, (2) a decreased
buffering capacity of the saliva which increases the risk of dental caries, (3)
the oral flora becomes more pathogenic, (4) dental plaque levels accumulate due
to a patient’s impaired oral hygiene, (5) demineralization of teeth occurs as
well as tooth decay, (6) and there can be accelerated periodontal disease.
About 40% of patients receiving cancer chemotherapy report having dry mouth when
getting cancer chemotherapy. It usually, however, resolves itself within a year
after treatment stops. Meanwhile, more than 90% of patients who receive head and
neck radiation have long-term dry mouth when the parotid gland is irradiated
directly. Unfortunately, decreased salivary flow can be an irreversible problem
in the case of head and neck radiation.
Additionally, pre-existing diseases such as diabetes, hypothyroidism and
rheumatoid arthritis or other immune mediated diseases are also associated with
decreased salivary flow and the effect of chemotherapy or head and neck
radiation would be additive.
A dental examination prior to beginning cancer treatments is an important step.
Dental care may also be needed more frequently during cancer treatment.
Based on salivary flow assessment (the amount of saliva), advice may include:
• Increasing one’s adequate daily fluid intake to include 64 ounces of
non-caffeinated and non-alcoholic fluids (e.g., water),
• Using a soft toothbrush with a gentle toothpaste, often without sodium lauryl
• Flossing 1 to 2 times daily,
• Taking a prescribed topical fluoride application daily
• Taking a remineralizing solution such as Caphosol which has been shown to
reduce cancer treatment associated mucositis (oral sores) due to radiation or
• Taking a prescribed salivary stimulant such as Pilocarpine 5-7.5 mg 4
times/daily or Cevimeline 30-60 mg 3 times/daily may be helpful.
• Edentulous patients who wear dentures may also need additional advice from
their dentists on disinfecting their dentures, and
• Finally, over the counter products developed for patients with dry mouth can
be used frequently to improve one’s comfort level.
Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ). National
Cancer Institute. 2007; 1-6.
Garg AK, Malo M. JADA. 1997;128: 1128-1133
About our Author:
Susan Zunt, DDS, MS is Professor of Oral and
Maxillofacial Pathology and Chair of the Department of Oral Pathology, Medicine
and Radiology at Indiana University School of Dentistry, Indianapolis, Indiana,
and member of the Oral Pathology Group Laboratory.
She is a graduate of Case Western Reserve University School of Dentistry. She
received a masters degree from Indiana University in Oral Pathology with a minor
in Oral Medicine. She is a Fellow of the American Academy of Oral and
Maxillofacial Pathology and a Diplomate of the American Board of Oral and
She served as the Director of Education for the AAOMP. She is currently the
AAOMP President, installed at the AAOMP annual meeting in Montreal, Quebec,
Canada. She is a member of the American Dental Association. Dr. Zunt is a member
of the American Dental Education Association. She has served as Chair of the
ADEA Council of Faculties and of the Section on Pathology.
Dr. Zunt maintains an active practice in diagnostic surgical oral pathology and
clinical oral pathology. Her research and practice interests include oral
manifestations of disease, oral cancer and precancer and diagnosis and
management of salivary gland dysfunction.